老年脑梗死后吞咽困难患者发生吸入性肺炎的影响因素分析及预测模型构建-现代医学

老年脑梗死后吞咽困难患者发生吸入性肺炎的影响因素分析及预测模型构建

单位：南京市中心医院老年科, 江苏南京 210000

分类号：R743

出版年·卷·期（页码）：2025·53·第二期（279-286）

摘要：

目的：探讨老年脑梗死后吞咽困难患者住院期间发生吸入性肺炎的危险因素并构建预测模型。方法：回顾性分析2022年3月至2024年3月于南京市中心医院住院治疗的308例老年脑梗死后吞咽困难患者的临床资料，根据住院期间是否出现吸入性肺炎分为吸入性肺炎组(n=73)和非吸入性肺炎组(n=235)。采用单因素分析比较两组临床风险因素，进一步通过多因素Logistic回归分析筛选出独立危险因素，根据其回归系数赋值纳入预测模型，并绘制ROC曲线分析模型的预测价值。结果：本研究纳入308例老年脑梗死后吞咽困难患者，吸入性肺炎发生率为23.70%(73/308)。多因素Logistic回归分析显示，呕吐(OR=1.508，95%CI:1.107～6.164)、安置胃管(OR=1.317，95%CI：1.057～4.681)、体位不当(OR=2.386，95%CI：1.285～7.286)、咀嚼肌瘫痪(OR=2.012，95%CI:1.149～6.815)、长期卧床(OR=2.764，95%CI：1.328～7.863)、无吞咽功能训练(OR=3.085，95%CI：1.508～8.937)以及NIHSS评分＞10(OR=3.886，95%CI：1.559～10.693)是老年脑梗死后吞咽困难患者发生吸入性肺炎的风险因素。根据危险因素构建风险预测模型，该模型ROC曲线下面积为0.809(95%CI：0.731～0.887)，灵敏度和特异度分别为0.76和0.79。结论：呕吐、安置胃管、体位不当、咀嚼肌瘫痪、长期卧床、缺乏吞咽功能训练以及较高的NIHSS评分(＞10)是老年脑梗死后吞咽困难患者发生吸入性肺炎的独立风险因素。基于这些风险因素构建的预测模型具有较高的预测价值，可为临床护理人员识别高危患者、制定个性化预防和护理策略提供重要参考，帮助降低吸入性肺炎的发生率，改善患者预后。

Objective: To analyze the risk factors and construct a prediction model for aspiration pneumonia in patients with post-stroke dysphagia. Methods: A retrospective analysis was conducted on the clinical data of 308 elderly patients with post-stroke dysphagia who were hospitalized in Nanjing Central Hospital from March 2022 to March 2024. The patients were divided into an aspiration pneumonia group(n=73) and a non-aspiration pneumonia group(n=235) based on whether they developed aspiration pneumonia during their hospital stay. Univariate analysis was used to compare clinical risk factors between the two groups. Independent risk factors were further identified through multivariable Logistic regression analysis. Based on their regression coefficients, these factors were incorporated into the predictive model, and the model's predictive value was evaluated by plotting a ROC curve. Results: This study included 308 elderly patients who developed post-stroke dysphagia, with an incidence rate of aspiration pneumonia of 23.70%(73/308). Multivariate Logistic regression analysis showed that vomiting(OR=1.508, 95%CI:1.107-6.164), nasogastric tube placement(OR=1.317, 95%CI:1.057-4.681), improper positioning(OR=2.386, 95%CI:1.285-7.286), masticatory muscle paralysis(OR=2.012, 95%CI:1.149-6.815), prolonged bed rest(OR=2.764, 95%CI:1.328-7.863), lack of swallowing function training(OR=3.085, 95%CI:1.508-8.937), and NIHSS score>10(OR=3.886, 95%CI:1.559-10.693) were risk factors for aspiration pneumonia in elderly patients with post-stroke dysphagia. A risk prediction model was constructed based on these factors, with an area under the ROC curve of 0.809(95%CI:0.731-0.887), and sensitivity and specificity of 0.76 and 0.79, respectively. Conclusion: Vomiting, nasogastric tube placement, improper positioning, masticatory muscle paralysis, prolonged bed rest, lack of swallowing function training and a higher NIHSS score(>10) are independent risk factors for aspiration pneumonia in elderly patients with post-stroke dysphagia. The predictive model constructed based on these risk factors has a high predictive value, providing important reference for clinical caregivers to identify high-risk patients and develop personalized prevention and care strategies, helping to reduce the incidence of aspiration pneumonia and improve patient outcomes.

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